Candidates poke at gorilla of health reform, but can they tame it?

In an online survey posted this fall on the website, we asked respondents how important it is that the next president and Congress enact substantial reforms of the healthcare system. With 130 votes in as of this writing, 73% answered very important and 15% somewhat important. Only 9% answered not important. Another 3% didn't know.

We know, of course, that this is not a scientific survey, but it does offer some guidance about attitudes in the radiology community. We also know that by being involved in that community, the respondents probably have an above-average knowledge of healthcare issues. And we know, based on their answers, that all but a handful of the respondents agree that the U.S. healthcare system is in distress, if not broken. Fifteen years after Bill and Hillary Clinton tackled the healthcare quagmire, the issue is back with a vengeance and the problems are more acute. The number of uninsured, now estimated at 47 million, has continued to increase, as have costs, to the point where healthcare now makes up 16% of the gross domestic product and accounts for about one-quarter of federal spending. Commonly measured health outcomes, however, often lag other industrialized nations and, in some instances, even emerging nations.

The options for dealing with these issues proposed by the two leading presidential candidates, John McCain and Barak Obama, couldn't be more different. McCain proposes a radical restructuring of the health insurance market in a way that would probably eliminate employer-provided health insurance, which covers 61% of the U.S. population, and rely on tax credits for the purchase of private health insurance. Obama proposes a plan that continues to rely on employer-provided healthcare and taxes those who don't offer it to help provide coverage for the uninsured.

In this issue, we've summarized the plans of the two candidates and also taken a look at what healthcare reform means for radiology. There are some big issues at stake for our specialty, including reform of the sustainable growth rate, new efforts to require proof of the effectiveness of technology innovations such as imaging, and more investments in IT technology to improve the quality and effectiveness of healthcare. All of these efforts could easily be accommodated under either of the candidate's health plans.

More difficult to predict is how the plans of McCain or Obama would affect radiology. A few early conclusions are possible.

It seems fairly clear that the McCain plan, by eliminating the employer deduction for health insurance and setting fairly low tax deductions for those who would need to purchase it, would reduce the amount of money available for healthcare. It is also likely that his plan would not do very much to reduce the number of uninsured. It does have the virtue of simplicity, but it would face tough sailing in what is likely to be a Democratic Congress. More gridlock?

The Obama plan is more complex and more costly (funded in part by higher taxes on those earning more than $250,000 per year), but it would probably significantly reduce the number of uninsured. The relative success of the state reform plan adopted by Massachusetts suggests that such an approach is feasible, although costs remain a big question. The Obama plan would also involve much more regulation of healthcare and insurance. Obama would probably be able to get some form of it through a Democratic Congress.

Ultimately, it may come down to two questions: Do you trust the free market to make good healthcare available to all who want it at a reasonable cost (the McCain plan)? Or do you believe the federal government can regulate a big and rather complex system in a way that makes healthcare available to all who want it a reasonable cost (the Obama plan)?